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Children have had a few similar experiences, and therefore they often have little idea of what to expect in the testing situation. Finally, the many developmental stages that characterize childhood and adolescence imply that assessors must be familiar with development to be able to tailor their rapport-building strategies to the unique needs of children at various stages. We have already mentioned that rapport building is a process that evolves throughout testing. However, we feel that using a title is important in the time-limited, task-oriented assessment situation because it sets the stage that you are a professional (albeit a caring, friendly, and respectful one) who will be working with the child, and not a friend who will play with the child. For younger children, some authors even recommend a period of play to allow the children to become more accustomed to the examiner. In our experiences, such rapport-building strategies should be used cautiously and sparingly. For many children, the assessor may be perceived as simply delaying the inevitable by using these strategies. In our experience, one of the best rapportbuilding strategies is to begin the assessment tasks quickly, so that the child begins to realize that the procedures will not be as bad as they imagined. Periods of play before the evaluation are especially problematic if structured testing is to follow. Young children often have difficulty switching from unstructured to structured tasks (Perry, 1990). Of course, the importance of rapport with parents will depend on the degree of their involvement in the testing. Although many evaluations are conducted at the request of a parent, there are also many situations in which a child is referred by others. For many parents, acknowledging that their child might have some type of disability is quite traumatic and can evoke a sense of failure. Assessors should attempt to conform his or her posture, movements, speed of speech, voice tone and volume, etc. Assessors should tailor their vocabularies to match the vocabularies of the person being tested. Few things impede the establishment of rapport as much as repeatedly using words and expressions that are unfamiliar to those with whom you are speaking. Barker (1990) also emphasizes that the development of rapport is continuous throughout the testing process. Although it is certainly true that once it is well established, rapport can withstand a lot of stress, it nevertheless can be damaged or even destroyed at any time if continuing attention is not paid to maintaining it" (p. An assessor should be sensitive to these dynamics and allow the parents to express their concerns at some point during the testing. Additionally, the parents should be supported in their role of getting help for their child. For example, an assessor might tell the parents how lucky their child is to have parents who care enough to obtain help for him or her, and not just let things get worse. Several reasons were given for starting with structured tasks in testing children in an effort to enhance rapport. As one would expect, such an impression is very damaging to the development of rapport. Such a call is a professional courtesy that greatly enhances the collaborative effort. It sets the tone for the teacher being involved in the evaluation as a valued professional who has much to offer in the assessment of the child. Conclusions In this chapter, some non-specifics of the clinical assessment of children were discussed. Developing a collaborative, respectful, and trusting working relationship is crucial to a successful evaluation. Being able to develop rapport is a skill that often takes years of practical experience to develop fully.

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The authors reported the following: · There were no significant differences between the three groups in terms of attendance records, rates of special education placement, and tests of reading, math computation, and math application. Probable Implementers Public and private early childhood programs Funding Funding for the Infant Health and Development Program was provided by the · · · · · · March of Dimes Foundation National Institute of Child Health and Human Development Pew Charitable Trusts Robert Wood Johnson Foundation Stanford Center for the Study of Families, Children, and Youth U. The cost of delivering the three programmatic components was estimated at that time to be $15,146 per year per child. The investigators suggested that this high cost could have been reduced to $8,806 per year per child if the child care centers were located in the community rather than at a central location, if transportation costs were reduced, and if the teacher-to-child ratio at the child care center were increased from two-to-six to two-to-eight. The home visitor provided parents with health and developmental information, along with family support. In addition, the home visitor implemented two specific curricula, the first of which emphasized cognitive, linguistic, and social development through games and activities for the parent to use with the child, while the second involved a systematic approach to help parents manage selfidentified problems. Teacher-child ratios were one-to-three for children age 12 to 23 months and one-to-four for those age 24 to 36 months. Class sizes were six children for those under 24 months of age and eight children for those 24 to 36 months of age. Parent Groups: Beginning at 12 months, bimonthly parent group meetings provided parents with information on child rearing, health and safety, and other parenting concerns, along with some degree of social support. Issues to Consider this program received a "proven" rating for the indicators "Children ages 0 to 5 exhibiting ageappropriate mental and physical development," and "Babies born weighing more than 5. Note that during the course of the trial there were no accidents or serious infectious epidemics noted by program staff. At age 8, the intervention group received lower ratings than the control group on a measure of physical limitations in behavior, and the lighter low birth weight group received lower ratings than their control counterparts on measures of social limitations due to behavior. No differences in illness or number of hospitalizations were noted for this group. As participants aged, fewer significant differences remained between the intervention and comparison groups. In addition, Hollomon and Scott (1998) found no significant differences between the intervention and control groups at age 9 for attendance records, rates of special education placement, reading scores, or math achievement. A number of additional evaluations have been conducted for this program (all of which included at least one of the original study authors), but we include here only those studies with methodologies meeting the Promising Practices Network criteria. Michael Hardin, "Early Intervention for Low Birthweight, Premature Infants: Participation and Intellectual Development," American Journal on Mental Retardation, Vol. Pope, "Contribution of Early Intervention and Early Caregiving Experiences to Resilience in LowBirthweight, Premature Children Living in Poverty," Journal of Clinical Child Psychology, Vol. Casey, "Early Intervention: the Moderating Role of the Home Environment," Applied Developmental Science, Vol. Meinert, "Early Intervention in Low-Birth-Weight Premature Infants: Results Through Age 5 Years from the Infant Health and Development Program," Journal of the American Medical Association, Vol. Brooks-Gunn, Jeanne, Fong-ruey Liaw, and Pamela Kato Klebanov, "Effects of Early Intervention on Cognitive Function of Low Birth Weight Preterm Infants," Journal of Pediatrics, Vol. Brooks-Gunn, Jeanne, Pamela Kato Klebanov, Fong-ruey Liaw, and Donna Spiker, "Enhancing the Development of Low-Birthweight, Premature Infants: Changes in Cognition and Behavior over the First Three Years," Child Development, Vol. Scott, "Influences of Birth Weight on Educational Outcomes at Age 9: the Miami Site of the Infant Health and Development Program," Developmental and Behavioral Pediatrics, Vol. Infant Health and Development Program, "Enhancing the Outcomes of Low-Birth-Weight, Premature Infants: A Multisite, Randomized Trial," American Medical Association Journal, Vol. Meinert, "Results at Age 8 Years of Early Intervention for Low-Birth-Weight Premature Infants," Journal of the American Medical Association, Vol. LaVange, "Infant Health and Development Program for Low Birth Weight, Premature Infants: Program Elements, Family Participation, and Child Intelligence," Pediatrics, Vol. Spiker, Donna, Joan Ferguson, and Jeanne Brooks-Gunn, "Enhancing Maternal Interactive Behavior and Child Social Competence in Low Birth Weight, Premature Infants," Child Development, Vol. The program has since been modified to target kindergarten through sixth-grade students, but the modified program has not been evaluated and the information reported here is only for the evaluated, fourth-grade to ninth-grade program. The cigarette smoking prevention component taught students the skills necessary to resist pressures to smoke cigarettes, while the physical fitness component helped students to begin a regular program of endurance exercise designed to improve cardiovascular fitness. Program Participants As evaluated, the program targeted fourth-grade to ninth-grade students. Evaluation Methods the Know Your Body program has been evaluated in four major studies, all of which focused on the effects of the program on chronic disease, cardiovascular risks, and cancer-related risk factors, including smoking. A brief description of the two evaluations follows: Bronx, New York (Walter et al.

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In this case, background information was particularly important for corroborating rating scale information and indentifying treatment objectives. Strengths and Weaknesses the TrF remains one of the most widely used of the teacher-completed behavior rating scales. In addition to its popularity and familiarity with a large number of professionals, the strengths of the TrF include: 1. The large research literature on the TrF and its predecessors which demonstrates good correspondence between the TrF and other indicators of child functioning, particularly on externalizing behaviors. The exclusion of children with mental health or special education services in the normative sample, indicating that such children are not represented. Therefore, its content reflects the research that went into developing these diagnostic criteria, which is excellent for some disorders but more suspect for others especially for children (Widiger et al. The content of these forms is mostly identical; however, they also each include some domains that may be particularly developmentally relevant. Instead, symptoms of certain disorders can be selected based on the specific purpose of the evaluation. Using this method, any item rated as being present "Often" or "Very Often" is considered to indicate the presence of the symptom, and any item rated as "never" or "Sometimes" is considered to indicate the absence of the symptom. Children receiving special education services were not included, making this sample a normal rather than normative sample. In addition to being somewhat geographically limited, there was great overrepresentation of Caucasian children, particularly for the teacher rating sample, with that sample being 95% Caucasian, 2. For example, a diagnosis of generalized anxiety Disorder (gaD) showed a sensitivity rate of 0. However, this issue is of less concern given the highly similar framework under which these measures were developed and the true intent of these measures. In addition, the symptomcount method provides a very easy method for combining information from multiple informants, which as the available data clearly suggest also provides the best correspondence to clinical diagnoses. Specifically, a symptom can be considered present if endorsed by any informant. The lack of a large normative base; thus, norm-referenced interpretations should not be made from this rating scale system. Instead, such decisions must be based on a combination of many sources of information. Conners, 3rd Edition (Conners-3) Parent Rating Scale the Conners-3 (Conners, 2008a) Parent rating Scale (Conners-3-P) is the most recent revision to a widely used behavior rating scale system. Scale content the Conners-3-P includes five empiricallyderived scales: Hyperactivity/Impulsivity, executive Functioning, Learning Problems, aggression, and Peer relations. The Conners-3-P includes screening items for depression and anxiety, as well as impairment items for home, school, and social relationships. These critical items are particularly geared toward severe conduct problem behaviors. Two open-ended questions regarding other concerns and particular strengths/ skills are also included. Detailed information on the generation and selection of items is provided in the Conners-3 manual (Conners, 2008a). Separate norms are used for boys and girls, as is the case for the other versions of the Conners-3. Data reported by Conners (2008a) indicate that the normative sample closely reflects the Census statistics. This representativeness is a notable improvement over previous versions of the Conners rating scale, in that the previous samples were predominantly Caucasian. Correlations with analogous scales from the teacher and self-report forms of the Conners-3 were all moderate. Differential validity evidence also indicates that the Conners-3-P was successful in distinguishing both a general population sample and within clinical samples.

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All records related to your involvement in this research study will be stored in a locked file cabinet. Your identity on these records will be indicated by a case number rather than by your name, and the information linking these case numbers with your identity will be kept separate from the research records. Will this research study involve the use or disclosure of my identifiable medical information? This research study will involve the recording of current and/or future identifiable medical information from your hospital and/or other. The information that will be recorded will be limited to information concerning the diagnostic tests 42 that have been performed related to Premature Ovarian Failure, as well as any pertinent medical or family history. Who will have access to identifiable information related to my participation in this research study? In addition to the investigators listed on the first page of this authorization (consent) form and their research staff, the following individuals will or may have access to identifiable information (which may include your identifiable medical information) related to your participation in this research study: Authorized representatives of the University of Pittsburgh Research Conduct and Compliance Office may review your identifiable research information (which may include your identifiable medical information) for the purpose of monitoring the appropriate conduct of this research study. In unusual cases, the investigators may be required to release identifiable information (which may include your identifiable medical information) related to your participation in this research study in response to an order from a court of law. If the investigators learn that you or someone with whom you are involved is in serious danger or potential harm, they will need to inform, as required by Pennsylvania law, the appropriate agencies. The name of the participants, and family members enrolled, and all personal identifying information, such as address, social security number, and date of birth, will be removed. Therefore, the Biobank will not give out your name, or other information that identifies you, your family member or children, to the scientists who receive the samples. However, the scientists will have some data about you, such as age, sex, diagnosis, race, and outcomes of the initial study. For how long will the investigators be permitted to use and disclose identifiable information related to my participation in this research study? The investigators may continue to use and disclose, for the purposes described above, identifiable information (which may include your identifiable medical information) related to your participation in this research study for a minimum of seven years after final reporting or publication of a project. May I have access to my medical information that results from my participation in this research study? Before agreeing to participate in this research study, or at any time during your study participation, you may discuss your care with another doctor who is not associated with this research study. You are not under any obligation to participate in any research study offered by your doctor. May I withdraw, at a future date, my consent for participation in this research study? You may withdraw, at any time, your consent for participation in this research study, to include the use and disclosure of your identifiable information for the purposes described above. Your decision to withdraw your consent for participation in this research study will have no effect on your current or future relationship with the University of Pittsburgh. If I agree to take part in this research study, can I be removed from the study without my consent? The investigator or sponsor may decide to stop you from taking part in this study at any time. You could be removed from the study for reasons related only to you or because the entire study is stopped. The sponsor, investigator, Food and Drug Administration, or Institutional Review Board may stop the study at any time. You may withdraw from the study at any time and you may request that your sample be permanently removed if it has not already been used. I understand that I am encouraged to ask questions about any aspect of this research study during the course of this study, and that such future questions will be answered by a qualified individual or by the investigator(s) listed on the first page of this consent document at 46 the telephone number(s) given. I understand that I may always request that my questions, concerns or complaints be addressed by a listed investigator. Any questions the individual(s) have about this study have been answered, and we will always be available to address future questions as they arise. I further verify that no research component of this protocol was begun until after this consent form was signed. Your responses will provide valuable information that will help with our research study. Please indicate if you have been previously diagnosed with any of the following: Please note when you were diagnosed and comment if necessary.

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Therefore, domains of central importance in the evaluation of response to treatment are adaptive behavior, comorbid symptoms, quality of life, and family functioning (Wolery & Garfinkle, 2002). These components were selected empirically; that is, they have been demonstrated to be relevant to identification, differential diagnosis, service delivery, evaluation of outcome, or a combination of these in multiple empirical investigations. We covered a wide range of assessment strategies and tools, not only those with empirical support but also those in wide use that may not be supported by data, and new instruments that have not yet been studied. There is not always good correspondence between clinical practices and research (Luiselli et al. Some of the domains and instruments we reviewed are nearly universal in research studies but are rarely used in clinical practice. Very few studies have directly compared different instruments, and thus there is little empirical basis to guide practitioners who are selecting among different assessment tools. Similarly, the incremental validity of the assessment domains we conceptualize outside the core battery has not been examined. But even though challenges remain, we have come a long way in the past few decades. As recently as 10 years ago, autism was considered a rare disorder; few clinicians knew how to evaluate it, or even considered it in a differential diagnosis. Autism was diagnosed through subjective clinical opinion, without the use of objective measures of development or behavior. As consensus about the diagnosis has been achieved, a number of standardized interviews and observational measures have been developed. Competent clinical evaluation now assumes the use of objective measures; funding and publication require it. This article is a first attempt at reviewing the evidence basis for tools currently in existence. Burlington: University of Vermont, Research Center for Children, Youth, and Families. The Aberrant Behavior Checklist: A behavior rating scale for the assessment of treatment effects. The facilitation of social-emotional understanding and social interaction in high-functioning children with autism: Intervention outcomes. Central coherence and cognitive shifting in relation to social improvement in high-functioning young adults with autism. Exploring the borderlands of autistic disorder and specific language impairment: A study using standardized instruments. Teaching on-task and on-schedule behaviors to high-functioning children with autism via picture activity schedules. Benefits and pitfalls in the merging of disciplines: the example of developmental psychopathology and the study of persons with autism. The Vineland Adaptive Behavior Scales: Supplementary norms for individuals with autism. Measuring developmental progress of children with autism spectrum disorders on school entry using parent report. The relationship between executive function abilities, adaptive behavior, and academic achievement in children with externalizing behavior problems. Domains of the Childhood Autism Rating Scale: Relevance for diagnosis and treatment. Communicative alternatives to challenging behavior: Integrating functional assessment and intervention strategies (pp. The criterion-related validity of the Childhood Autism Rating Scale and the Autism Behavior Checklist. A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children. The stability of cognitive and behavioral parameters in autism: A 12-year prospective study. Validity and reliability of the Childhood Autism Rating Scale with autistic adolescents. A behavioral analysis of degree of reinforcement and ease of shifting to new responses in a Weigle-type card sorting problem.

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What does the close emotional relationship with the parent provide that other adults cannot replicate? To answer such questions, researchers have focused on the development of security, confidence, and trust between infants and toddlers and their parents. This central feature of early relationships is captured by the concept of "attachment security. Indeed, long ago the field was riveted by evidence that toddlers who were languishing in institutional settings could be made to thrive cognitively, emotionally, and physically simply by providing them with loving care-even if this meant that they were moved onto wards for young women with mental retardation who held them, played with them, hugged them, and lavished attention on them. As dramatic, the remarkable recovery observed today in children adopted from orphanages in Romania and other areas of the world speaks to the power of consistent care, attention, and affection in the lives of young children. Virtually all infants develop close emotional bonds, or attachments, to of Sciences. These early attachments constitute a deeply rooted motivational system that ensures close contact between babies and adult caregivers who can protect, nurture, and guide their development. Indeed, the infant appears to be so strongly motivated and prepared to develop attachments to one or more caregivers that, given the opportunity to interact regularly with even a modestly responsive caregiver, he or she will develop an emotional tie to that person. This might be called, therefore, the self-efficacy function of early attachment relationships. Well before the first birthday, infants clearly exhibit preferences for and special responsiveness to certain adults. They advance into the world to explore, but return periodically to touch base with these people. If frightened, they seek proximity and physical contact, and when forced to be separated from them, they often protest, sometimes frantically. Secure base behavior describes the presence of an attachment bond, and toddlers show in these behaviors that they are gradually acquiring an awareness of the psychological qualities of other people (Stern, 1985; Tomasello et al. Security of Attachment Although virtually all infants become attached to their caregivers, attachment relationships differ in how much security they provide. In contrast, children whose exploratory play is disrupted because they are preoccupied with the caregiver, who avoid or resist contact after separation, display distress and anger upon reunion, and are not easily comforted are considered insecurely attached. Recent research on children who have experienced highly disruptive, sometimes abusive care has led to important refinements in views of insecure attachment. Studies of physically abused infants and toddlers have noted significantly elevated proportions of insecure attachments (Crittenden, 1988; Lyons-Ruth et al. Studies of neglected children, such as those reared in orphanages or removed from their homes because of severe neglect, have shown that some, but certainly not all, of these children do not seem to organize their behavior in meaningful ways around one or a few adults. They do not fit typical patterns of insecurity, but rather display inconsistent and disorganized responses to their caregivers. We are far from being able to say anything definitive about these disordered patterns of attachment behavior, but they form one of the cores of the nascent field of infant mental health (Osofsky and Fitzgerald, 2000; Zeanah, 2000). This field of clinical research, albeit new, highlights what has become increasingly evident: infants and young children have rich emotional/psychological lives and can suffer in ways that heretofore had never been realized. The interest in documenting unusual patterns of attachment behavior in search of a better understanding of infant mental health and disorder increases the need to broaden cultural understanding of attachment and the assessment of its security. It is important to realize that the laboratory assessments that have formed the basis for much of the research on attachment security have been designed to produce only mild challenges for the infant. In cultures in which separations rarely occur, it is presumed that these experimentally imposed separations may take on a very different meaning for the infant. Indeed, research on Japanese infants who are rarely separated from parents during their first year initially demonstrated high rates of presumably insecure attachment (Takahashi, 1986, 1990). A study of desirable and undesirable attachment behavior among white and Hispanic (Puerto Rican) mothers provides a compelling illustration of these differences (Harwood et al. The white mothers preferred that toddlers balance autonomy and relatedness (playing at a distance and involving the mother prior to separation and greeting the mother happily during the reunion), and they disliked clinginess (clinging to the mother prior to separation, crying continuously during separation, and being unhappy during the reunion). In contrast, Puerto Rican mothers preferred that toddlers display respectfulness (sitting near the mother and waiting for a signal before playing with the toys prior to separation, waiting quietly for the mother to return during separation), and they disliked highly active or avoidant (ignoring the mother before, during, and after separation) behavior. We strongly suspect that, across all cultures, children form attachments and use parents as sources of security and comfort.

Transplacental infections

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The risk for perforation is increased independently among breastfeeding women and among women 36 weeks postpartum, compared with non-postpartum women; however, the absolute risk for perforation remains low (11­62,65). Comment (breastfeeding): Certain women might be at risk for breastfeeding difficulties, such as women with previous breastfeeding difficulties, certain medical conditions, or certain perinatal complications and those who deliver preterm. For these women, as for all women, discussions about contraception for breastfeeding women should include information about risks, benefits, and alternatives. Department of Health and Human Services recommends increasing the proportion of infants initially breastfed, exclusively breastfed through 6 months of life, and continuing breastfeeding through at least 1 year of life as key public health goals (10). Early postpartum placement has similar or increased risk for expulsion compared with immediate postplacental placement. Although immediate postplacental placement at the time of cesarean delivery might have increased risk for expulsion compared with interval placement, risk appears lower than that for placement at the time of vaginal delivery. Evidence for infection, perforation, and removals for pain or bleeding are limited; however, these events are rare (11­62). Clarification (breastfeeding): Breastfeeding provides important health benefits for mother and infant. Restrictive procedures: decrease storage capacity of the stomach (vertical banded gastroplasty, laparoscopic adjustable gastric band, or laparoscopic sleeve gastrectomy) b. Malabsorptive procedures: decrease absorption of nutrients and calories by shortening the functional length of the small intestine (Roux-en-Y gastric bypass or biliopancreatic diversion) 1 1 1 1 1 1 1 1 1 1 1 1 - - - - - 1 1 - 1 1 - Cardiovascular Disease Multiple risk factors for atherosclerotic cardiovascular disease. Adequately controlled hypertension 1 2 - 1 1 Clarification: For all categories of hypertension, classifications are based on the assumption that no other risk factors for cardiovascular disease exist. Clarification: For all categories of hypertension, classifications are based on the assumption that no other risk factors for cardiovascular disease exist. Stroke (history of cerebrovascular accident) this condition is associated with increased risk for adverse health events as a result of pregnancy (Box 2). Valvular heart disease Complicated valvular heart disease is a condition associated with increased risk for adverse health events as a result of pregnancy (Box 2). Evidence: Antiphospholipid antibodies are associated with a higher risk for both arterial and venous thrombosis (95,96) See table footnotes on page 30. The category should be assessed according to the severity of thrombocytopenia and its clinical manifestations. In women with very severe thrombocytopenia who are at risk for spontaneous bleeding, consultation with a specialist and certain pretreatments might be warranted. Not receiving immunosuppressive therapy Initiation 2 1 Continuation 1 Initiation 2 1 Neurologic Conditions Headaches a. For more information see the International Headache Society Classification, 3rd edition. Without prolonged immobility 1 1 1 1 1 1 1 1 - - Clarification: If a woman is receiving psychotropic medications or St. Initiation 4 2 1 2 Continuation 2 Initiation 4 1 1 1 Continuation 2 Clarification: If pregnancy or an underlying pathological condition. Unexplained vaginal bleeding (suspicious for serious condition) before evaluation Endometriosis Benign ovarian tumors (including cysts) Severe dysmenorrhea Gestational trophoblastic disease this condition is associated with increased risk for adverse health events as a result of pregnancy (Box 2). Comment: the risk for expulsion immediately postevacuation for gestational trophoblastic disease is unknown. Confirmed gestational trophoblastic disease (after initial evacuation and during monitoring) i. Cervical ectropion Cervical intraepithelial neoplasia Cervical cancer (awaiting treatment) Breast disease Breast cancer is associated with increased risk for adverse health events as a result of pregnancy (Box 2). Past and no evidence of current disease for 5 years Endometrial hyperplasia Initiation 4 1 1 Continuation 2 Initiation 4 1 2 Continuation 2 Comment: Concern exists about the increased risk for infection and bleeding at insertion. Continuation 2 Comment: Concern exists about the increased risk for infection, perforation, and bleeding at insertion. Comment: Women with heavy or prolonged bleeding should be assigned the category for that condition. Endometrial cancer this condition is associated with increased risk for adverse health events as a result of pregnancy (Box 2). Uterine fibroids Initiation 4 1 Continuation 2 Initiation 4 1 2 2 See table footnotes on page 30.


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